Impact of body mass index on survival outcome in patients with differentiated thyroid cancer / Impacto do índice de massa corporal sobre o desfecho de sobrevida em pacientes com câncer diferenciado de tireoide

Abstract Introduction Increased body mass index is known to be associated with the high prevalence of differentiated thyroid cancers; however data on its impact on survival outcome after thyroidectomy and adjuvant therapy is scanty. Objective We aimed to evaluate the impact of body mass index on overall survival and disease free survival rates in patients with differentiated thyroid cancers. Methods Between 2000 and 2011, 209 patients with differentiated thyroid cancers (papillary, follicular, hurthle cell) were treated with thyroidectomy followed by adjuvant radioactive iodine-131 therapy and thyroid-stimulating hormone suppression. Based on body mass index, patients were divided into five groups; (a) <18.5 kg/m2 (underweight); (b) 18.5-25 kg/m2 (normal weight); (c) 26-30 kg/m2 (overweight); (d) 31-40 kg/m2 (obese) and (e) >40 kg/m2 (morbid obese). Various demographic, clinical and treatment characteristics and related toxicity and outcomes (overall survival, and disease free survival) were analyzed and compared. Results Median follow up period was 5.2 years (0.6-10). Mean body mass index was 31.3 kg/m2 (17-72); body mass index 31-40 kg/m2 was predominant (89 patients, 42.6%) followed by 26-30 kg/m2 seen in 58 patients (27.8%). A total of 18 locoregional recurrences (8.6%) and 12 distant metastasis (5.7%) were seen. The 10 year disease free survival and overall survival rates were 83.1% and 58.0% respectively. No significant impact of body mass index on overall survival or disease free survival rates was found (p = 0.081). Similarly, multivariate analysis showed that body mass index was not an independent prognostic factor for overall survival and disease free survival. Conclusion Although body mass index can increase the risk of thyroid cancer, it has no impact on treatment outcome; however, further trials are warranted.

Resumo Introdução Sabe-se que o aumento do índice de massa corpórea está associado à alta prevalência de câncer diferenciado de tireoide; entretanto, os dados sobre seu impacto no desfecho de sobrevivência após tireoidectomia e terapia adjuvante são escassos. Objetivo Objetivou-se avaliar o impacto do índice de massa corpórea nas taxas de sobrevida global e sobrevida livre de doença em pacientes com câncer diferenciado de tireoide. Método Entre 2000 e 2011, 209 pacientes com câncer diferenciado de tireoide (papilar/folicular/de células de Hurthle) foram tratados através de tireoidectomia, seguida de tratamento com iodo radioativo-131 adjuvante e supressão de hormônio estimulante da tireoide. Com base no índice de massa corpórea, os pacientes foram divididos em cinco grupos; (a) < 18,5 kg/m2 (baixo peso); (b) 18,5-25 kg/m2 (peso normal); (c) 26-30 kg/m2 (sobrepeso); (d) 31-40 kg/m2 (obesos) e (e) > 40 kg/m2 (obesos mórbidos). Várias características demográficas, clínicas e de tratamento e toxicidade associada e desfechos (sobrevida global e sobrevida livre de doença) foram analisadas e comparadas. Resultados O período médio de acompanhamento foi de 5,2 anos (0,6-10). O índice de massa corpórea médio foi de 31,3 kg/m2 (17-72); o índice de massa corpórea de 31-40 kg/m2 foi predominante (89 pacientes, 42,6%), seguido por 26-30 kg/m2, observado em 58 pacientes (27,8%). Observaram-se 18 recidivas locorregionais (8,6%) e 12 metástases distantes (5,7%). As taxas de sobrevida livre de doença e sobrevida global de 10 anos foram de 83,1% e 58,0%, respectivamente. Não foi encontrado impacto significativo do índice de massa corpórea nas taxas de sobrevida global ou sobrevida livre de doença (p = 0,081). Da mesma forma, a análise multivariada mostrou que o índice de massa corpórea não foi um fator prognóstico independente para sobrevida global e sobrevida livre de doença. Conclusão Embora o índice de massa corpórea possa aumentar o risco de câncer de tireoide, ele não tem impacto no resultado do tratamento; contudo, outros estudos são necessários.

Incidencia de cáncer de tiroides en la provincia de Río Negro / Incidence of thyroid cancer in Rio Negro province

Introducción: La incidencia del cáncer de tiroides (CT) ha ido en aumento en las últimas décadas. Existen pocos datos en nuestro país con respecto a la epidemiología del CT. Objetivo: Evaluar la incidencia de CT en la provincia de Río Negro (RN) durante el período 2004-2013. Métodos: Se revisaron todos los informes histológicos con diagnóstico de CT durante este período en el departamento de General Roca, que representa el 50% de la población de la provincia de RN. Se calcularon las tasas de incidencia y se dividió el período de estudio en 2 quinquenios para evaluar si existió un aumento de la misma. Se evaluaron además otras variables como: edad, sexo, tipo histológico, multicentricidad, presencia de adenopatías metastásicas y pertenencia al sistema de salud público o privado. Resultados: Encontramos una incidencia de 6,77 nuevos casos/100.000 hab/año (10,76 en mujeres y 2,48 en hombres). Cuando evaluamos el número de casos de CT por quinquenio, observamos 41 casos en el primero y 116 en el segundo, con una tasa de incidencia que aumentó de 4,52 a 9,30 /100.000 hab/año. Del total de los casos encontrados, un 98,7% de ellos fueron carcinomas papilares de tiroides (CPT), un 22,9% presentaba adenopatías metastásicas, un 36,9% fueron multifocales, un 80,2% mujeres y un 75,8% pertenecía al sector privado de salud. La media de tamaño tumoral fue de 19,9 ± 14,32 mm, sin diferencias significativas entre los 2 períodos de estudio. Se observó un aumento en la proporción de tumores < 10 mm en el último quinquenio (del 27% en el primero al 35% en el segundo). Si bien este aumento no fue significativo (p = 0,35), se evidencia una tendencia en ascenso de los microcarcinomas. Conclusión: La incidencia de CT en la provincia de RN es similar a la reportada en la literatura y observamos un aumento de la misma durante el período de estudio.

Introduction: The incidence of thyroid cancer (TC) has been increasing over the last twenty years or so. There are few data in our country with regard to the epidemiology of this disease. Objective: To assess the incidence of thyroid cancer in the province of Río Negro (RN) for the period 2004- 2013. Methods: All histological reports with TC diagnosis within the study period in the department of General Roca, which represents 50% of the population of RN province, were assessed. Incidence rates were calculated, and the study period was divided into two five-year segments to evaluate the possibility of an increased incidence. Other variables were also assessed, including age, sex, histological type, multicentricity, presence of metastatic lymph nodes, diagnosis and treatment, and whether in public or private health institutions. Results: There was an incidence of 6.77 new cases/100,000 inhabitants/year, (10.76 in women and 2.48 in men). Evaluation of the number of TC cases per five-year period showed 41 cases in the first period and 116 in the second, with an incidence rate that increased from 4.52 to 9.30/100,000 inhabitants/year. Almost all cases (98.7%) were found to be Papillary Thyroid Carcinoma, 22.9% showed metastatic lymph nodes, and 36.9% were multifocal. Also, of the total population in study, 80.2% were women, and 75.8% were treated in the private health sector. Mean tumour volume was 19.9 mm ± 14.32 mm, with no significant differences between the two study periods. An increase from 27% to 35% was observed in the proportion of tumours smaller than 10 mm in the second period. Although this increase was not statistically significanct (P = .35), a rising trend is observed. Conclusion: Incidence of TC in the province of RN is similar to that reported in the literature and an increase in its incidence was observed during the study period.

Evaluation of ultrasound application in diagnosis and clinical staging of thyroid cancers.

Objectives: The usage of Ultrasonography (US) in the diagnosis and management of patients with thyroid nodules and thyroid cancer is increasing. This method is also advocated for the pre-operative and post-operative diagnosis of cervical lymph node (LN) metastases. This article is trying to figure out the correlation between ultrasound features and pathological classification of thyroid carcinoma (TC). Materials and Methods: A total of 407 cases of patients with TC were selected from records between 2000 and 2006, which were used to analyze and compare the ultrasound features in different pathologic classification of TC. We grouped the US typing of TC according to the ultrasound features. Then, we implemented pre-surgery evaluation of TC by ultrasound assessment. Results: We classified these patients into six groups by ultrasound: (1) classical, (2) non-typical, (3) microminiaturize, (4) diffuse sclerosing, (5) medullary, and (6) undifferentiated. Ultrasonographic types of papillary TC: (1) classical, (2) microminiaturize, (3) diffuse, (4) cystic, (5) peripheral, (6) multi-nodules, (7) invasive, and (8) complicated Hashimoto. Grouping of the ultrasonic type of cervical LN metastasis: (1) cystic, (2) micro calcification, (3) macro-lymph, (4) microminiaturize, and (5) invasive. The ultrasound assessment of clinical staging had a higher sensitivity rate and specificity, and the accuracy rate of T stage was 93.9%. Conclusion: Ultrasound is a useful tool in the evaluation, characterization, quantification, and location of TC and cervical LN metastasis.

Association between Preoperative Serum TSH Level and Papillary Thyroid Cancers / 대한내분비외과학회지

PURPOSE: Recent research has shown that there is a relationship between the level of preoperative serum TSH and a papillary thyroid carcinoma. Therefore, this study examined the correlation between the serum TSH and papillary thyroid carcinoma. METHODS: The preoperative serum TSH level of papillary thyroid carcinoma and nodular hyperplasia of 418 patients from 2009 Jan. to 2011 Dec. was examined. The patients were divided into 3 groups, nodular hyperplasia, less than 1 cm micropapillary carcinoma and more than 1 cm papillary carcinoma, and their TSH levels were compared. RESULTS: Nodular hyperplasia and total papillary carcinoma was found in 98 (23.0%) and 322 (77.0%) patients, respectively. After dividing the patients according to the size of the mass, there were 224 (53.6%) patients with a mass less than 1 cm in size and 98 (23.4%) patients with a mass more than 1 cm in size. The preoperative serum TSH level of the 3 groups showed a significant difference, which was 1.180±1.168 μIU/ml in the nodular hyperplasia group, 1.670±1.224 μIU/ml in the micropapillary carcinoma group and 2.279±2.837 μIU/ml in the papillary carcinoma group (P<0.001). On the other hand, there were no significant correlations between the preoperative serum TSH level and gender, age, metastasis to lymph node, number of masses and extrathyroidal extensions. CONCLUSION: The larger size of the papillary thyroid carcinoma, the higher the preoperative high serum TSH level. Therefore, the stimulation of TSH can affect the progression of papillary thyroid carcinoma but more study will be needed.

Individualized thyrotropin suppression in patients with differentiated thyroid cancers / 中华内分泌代谢杂志

The epidemic characteristics of differentiated thyroid cancer(DTC)are changing, thyrotropin(TSH)suppressive therapy is also improving in recent years. The risks of recurrence and the death of patients, as well as the adverse effects of levothyroxine sodium treatment should be fully considered during thyroid hormone administration for patients of DTC. Hence, the degree of TSH suppression should be individualized in patients with DTC.